Episode 170 Weight Stigma in Pregnancy

Have you ever considered the impact of a simple medical term on a person's experience? Midwife Jenny Cunningham and Catriona Forbes of a research collective join us to unravel the complex issue of weight stigma in pregnancy.  Jenny shares her path from hands-on midwifery to academic research, while Catriona offers a personal narrative on the stigma she faced as an expectant mother, lending depth to our understanding of these early, often negative categorizations.

Language has power, especially in healthcare, and this episode sheds light on the need for respectful terminology when discussing body weight during maternity care. We've replaced the word "obesity" with "higher weight" to foster a stigma-free environment. Catriona provides invaluable insights into the response from individuals with higher body weights, and together, we discuss the evolution of our research methodology to ensure it's inclusive, community-based, and sensitive to the needs of those it aims to serve. We also tackle the practicalities of prenatal care, such as folic acid dosages and the importance of creating a healthcare environment free from anticipatory anxiety.

Lastly, we navigate the emotionally charged waters of maternity scans and medical conversations about body size. From the choice between induction and cesarean delivery to the importance of transparent and patient-centered communication, we underscore the crucial need for honesty and personalized care in addressing weight-related health risks. As we invite more voices to join our ongoing research, particularly from communities that are often unheard, we reaffirm our commitment to enhancing support for all expectant mothers through respectful dialogue and care.

Want to know more?
https://shameandmedicine.org/maternity-care-for-women-of-a-higher-weight-how-is-shame-experienced/
Contact Jenny  by email [e-mail] or DM via twitter or Instagram. Twitter: @djennymidwife  Instagram: @phdjennymidwife   

Thank you all for listening, My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.
If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth.
Keeping my podcast running without ads or sponsorship is important to me. I want to keep it free and accessible to all but it costs me a small amount each month to maintain and keep the episodes live, if you wish to contribute anything to support theobspod please head over to my buy me a coffee page https://bmc.link/theobspodV any donation very gratefully received however small.
Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor.
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and e...

Episode Transcript

Florence (00:01):
Hello, my name's Florence.
Welcome to the OBSPod.
I'm an NHS obstetrician hopingto share some thoughts and
experiences about my workinglife.
Perhaps you enjoy Call theMidwife.
Maybe birth fascinates you oryou're simply curious about what
exactly an obstetrician is.
You might be pregnant andpreparing for birth.

(00:22):
Perhaps you work in maternityand want to know what makes your
obstetric colleagues tick, oryou want some fresh ideas and
inspiration.
Whichever of these is the caseand, for that matter, anyone
else that's interested, the OBSpod is for you.

(00:53):
Episode 170, weight Stigma inPregnancy.
Today I have two very specialguests.
I have Jenny Cunningham, who'sa midwife, and I have Catriona
Forbes, part of a researchcollective, and we are going to

(01:22):
be talking all things weightstigma in pregnancy, which kind
of builds on the episode I didrecently episode 163, I saw on
social media that Jenny waslooking for people who'd
experienced pregnancy, who wereoverweight or had a bigger BMI
and we'll talk about whether BMIis a good thing or not and I
was interested because she'sdoing research in this area and

(01:47):
that's kind of how we connectedand we've got lots to talk about
today.
But I don't know if you want tostart Jenny with perhaps how
you got interested in this as atopic.

Jenny Cunningham (02:00):
Hi Florence, thank you very much and thank
you for the invite.
Very pleased to be here.
It was some years ago when Iwas working clinically as a
community midwife and we weresuddenly given a kind of sheet,
a checklist sheet, a brand newsheet which came in the booking
pack so the packs we use when wefirst meet women who are
pregnant to talk about theirpregnancy and kind of go through

(02:24):
various kind of conversationsand blood pressure and that kind
of thing.
And this new checklist was forwomen with a raised body mass
index of 30 or more and at thetime we hadn't been alerted to
this coming.
So it literally landed on thedesk and I found it very
negative.
It was talking about risks,really fairly negative kind of

(02:45):
of.
You know, tick, have you talkedabout shoulder dystocia?
Tick, have you talked aboutthis?
And that it felt quite adifficult conversation to have
with women right at the outsetand my kind of colleagues we
kind of talked about this and wejust found it quite difficult
and we were quite surprised byit Because of course a lot of
the things we talk about affectall women in pregnancy

(03:06):
potentially.
That's where my interest camestarted at.
So I did a small study,interview study a couple of
years later in my hospital trust, asking women about their
feelings, about theconversations we had.
So that that was the kernel ofthe idea and I've just kept that
with me.
I kind of follow lots of weightneutral kind of people and

(03:29):
activists and it just raised myinterest and I had an
opportunity to do a PhD and Ichose this topic and that's why
we are here today.

Florence (03:39):
Fantastic.
So I agree, I remember the kindof start of the idea that one
should have a guideline and ofdifferent rules in inverted
commas applying to depending onwhat the body mass index was

(04:11):
what one should or shouldn'ttalk to people about, and I
think it came from a place ofgood intention in terms of
analysis, in perhaps things likeembrace the maternal morbidity
and mortality that we wereseeing, perhaps a

(04:36):
disproportionate number of womenthat that fitted into those
categories represented in thosereports.
But I agree, I remember havingmany conversations with women in
my clinic where they were kindof saying, well, I'm pregnant
already and you telling me now,when there's nothing I can do

(04:56):
about it, but I have the risk ofthis and the risk of that and
of that, and making meabsolutely petrified of my
pregnancy is really unhelpful.
Yeah, catriona, I'm sure youmight like to chip in here and

(05:17):
tell us a bit about yourself andwhy you're involved in the
research collective.
Uh, sure, florence.

Catriona Forbes (05:24):
I got involved in the Research Collective Sure
Florence.
I got involved in the ResearchCollective after a call was put
out on a group on social mediathat I follow, and it was
Jenny's call for participants tocontribute to her Research
Collective as part of her PhDstudy into weight stigma in
pregnancy.
I had already had my child bythat point, so I have a almost

(05:49):
three and a half year old and myI mean my pregnancy was an
interesting one in that it tookplace entirely in 2020.
So that in itself had its ownflavour, unique to that period.
But, yeah, there were multiplepoints, I think, through my
experience experience ofpregnancy that had me asking a
lot of questions about how Ilike my experiences, I guess.

(06:13):
So I, from that firstconversation that Jenny
references as the one that youknow you have as you're booking
an appointment with your midwifewhich, checking back on my own
notes of it from four years ago,was a 51 minute telephone call
for me in COVID times, and fromthat 51 minute call of questions
that then decided a pathway,which was obviously that my

(06:37):
pregnancy would follow, I thinka weight management pathway.
I don't know what it's calledhigher weight pregnancy.
I have no idea what the actualofficial name for it is, but
essentially it meant I wasconsultant-led care Maybe that's
the actual name of it.
So I was immediately kind ofunder that pathway, based on
that initial conversation which,to be fair, my midwife just was

(06:58):
very much like it was just avery master of fact thing.
You've ticked a certain numberof boxes.
Anyone who ticks a certainnumber of boxes can end up on
this pathway.
These are the boxes that haveobviously kind of made you
eligible for it.
But it just did set a tone, Ithink, for then what felt like
how my pregnancy was then goingto be perceived and experienced,

(07:20):
I think.

Florence (07:22):
That's really interesting that it was just was
just kind of automatic default,is that right?
So you didn't have any kind ofsay in it?

Catriona Forbes (07:31):
Well, I mean I maybe did have a say.
I guess I didn't questionhaving a say.
It was I'd gone over athreshold that meant I was under
consultant-led care and Ididn't question that.
I just went to the appointmentsthat I received the letters
telling me to go to.
So, um, I didn't, I didn'tquestion why I, why that was
entirely necessary, or, or, yeah, I guess part of the kind of go

(07:55):
to the appointments that you'regiven is because you know you
expect you're given them for areason and you're pregnant and
are effectively now responsibleboth for yourself and someone
that's growing inside you.

Florence (08:07):
So, uh, you, you do as you think you're supposed to be
doing and did that feel likeI'm being well looked after
because I've ticked these boxesand therefore I'm going to have
this pathway, or did that makeyou feel apprehensive or worried

(08:29):
about your pregnancy?

Catriona Forbes (08:31):
I mean I was apprehensive before becoming
pregnant about my body size.
In healthcare in general, Ivery much fit the classic that's
now been studied extensivelyabout people who will avoid
seeking medical advice orconversations based on the
encounters of how your bodystarts to become or your weight

(08:54):
starts to become, part of thediscussion around anything that
you might actually be seekinghealth care for.
So I think pregnancy wasn'tsomething that I was fairly
apprehensive about anyway, andthen became pregnant and so then
it just felt like, well,definitely do all the things
you're told to do for fear ofsomething going wrong, and most

(09:15):
pregnant people, I think, feelthat way.
I don't think that's specificto people of a higher weight.
I think it's very much.
You don't necessarily questionmuch, especially perhaps the
first time around, and just gowith it.
I guess I had some experiencesthrough it that I did have a
particular negative reaction to,and then so when I saw Jenny's

(09:37):
call and the work that she wasdoing, I was just really
interested, I guess, in the factthat you know Jenny is a
midwife and has worked firsthandin delivering babies and
working with pregnant people,and so I always think it's great
if clinicians are actuallylooking to speak to the people
that are impacted by thedecisions that are, you know,

(09:58):
kind of taken at whatever level.

Florence (10:01):
Definitely that sort of has really nicely led us into
this idea of stigma and andweight stigma.
And, jenny, you sent me a greatblog which I will put in the
show notes for people to read.
But do you want to talk a bitabout what we mean by stigma or

(10:24):
weight stigma?

Jenny Cunningham (10:26):
Sure, I've got a really, I think, a really
nice definition of weight stigma, which I'll read out.
Is that OK?

Florence (10:32):
Yes.

Jenny Cunningham (10:33):
And this one which was published just two
years ago.
So weight stigma can be definedas prejudice and discrimination
due to weight or body size.
It includes experiences ofbeing stigmatized by others,
internalized weight orself-stigma, and anticipated or
expectation of stigma, all ofwhich have been linked to

(10:55):
negative health outcomes andpotentially life-limiting
disparities of evidence.
So that's not particularlyabout pregnancy, but that's just
about weight stigma as a whole,and I think that to me is a
really kind of holisticdefinition.
It talks about self stigma,which not all weight stigma
talks about, because weinternalize as human beings in
society what others feel aboutus.

(11:17):
And it also talks aboutexpectation of stigma, that
anticipation that you're goingto walk into that room be kind
of humiliated or judged in someway.
So I kind of really like thisdefinition.
And also the other thing itdoesn't use the words I'm going
to use it now.
I don't like it obesity.
It doesn't use the word bodymass.

(11:37):
It will determine body massindex either, and I think when
clinicians speak to I'm going tojust talk about kind of in the
maternity field to women andbirthing people, they will
rarely say obesity to theirfaces, but it will be in all the
written documents and of courseit's always in the press around

(11:57):
.
You know the original words onTV etc.
And obesity is known to be astigmatising word.
So I really try not to use it.
And you mentioned earlierFlorence body mass index and we
we know it's a contested term.
It doesn't accurately sayanything about someone's health.
It just tells us about people'sweight.

(12:18):
So I try, so I'm using higherweights or higher weight bodies,
and I talk to the researchcollective about what language I
should use, which is kind ofwhy I really wanted to have a
group of women and birthingpeople to support this work.
And I think, Catriona, we felthigher weight seemed
satisfactory, it seemed OK, itdidn't seem particularly good or

(12:41):
bad, it was fairly neutralenough, I think.
Was that how you'd agree?

Catriona Forbes (12:44):
Yeah, I would agree with that.
What was interesting, though,is that in the discussions with
the collectives, when we didmeet to have that kind of
conversation the first meetingto talk about some terminology
and how Jenny might want toapproach things there there
wasn't a universal response oragreement in.
You know, we didn't all thinkthe same way about what words
were or weren't okay, and that,I think, relates to kind of the

(13:08):
different relationships orpoints that we all were at with
our own bodies at that time andand how we'd experience things.
So, you know, there is kind ofmovement around removing the
stigmatization of the word fatand to use fat as a descriptor
and fat is just a descriptionit's in the context that you use
a word that gives it itsmeaning.

(13:28):
However, there's a lot of otherpeople that would have
responded really poorly ornegatively to to the use of the
word fat, and I think, certainly, if you'd put that in a
research call to say I'minterested in talking to fat
people who are pregnant, I don'tI don't think you'd have
necessarily had a a positiveresponse.
So, yeah, even in the researchcollective, it what it's been an

(13:51):
interesting experience, becausewe've been hearing each other's
stories and experiences andeven how we relate to the
language around, uh, how bodiesare spoken about.
But yeah, higher weight, Ithink the one we all just kind
of agreed was most neutralfundamentally.
It didn't instill really anynegative responses from anyone,

(14:12):
so it just felt like the mostneutral and kind of safest
approach.
And then, obviously, forresearch purposes, jenny was
then able to kind of put alittle asterisk with a
definition of what that wouldmean, you know, in BMI terms,
because ultimately I guess therejust has to be kind of put a
little asterisk with adefinition of what that would
mean, you know, in BMI terms,because ultimately I guess there
just has to be kind of aclinical outlook on it from a
research perspective.
So there was an ability toexpand on that without it

(14:35):
centering on BMI as kind of themeasure.

Jenny Cunningham (14:39):
Thank you, catriona, that's a really
helpful expansion of what Istarted to say.
So thank you.
And I did have to choose,you're quite right, bmi of 30 or
more, because that's a reallyhelpful expansion of what I
started to say.
So, thank you.
And I did have to choose,you're quite right, bmi of 30 or
more because that's wheninterventions start happening to
pregnant women and people.
So under that, as you know,people are treated the same
generally, unless there's aparticular medical condition.
But 30 or more is when thoseconversations start happening.

(15:00):
So I had to define it otherwisebecause I wanted to
particularly look at people whohave those conversations as
additional interventionspotentially.
And just to perhaps just add onhere about the collective, which
is more commonly talked aboutas an advisory group.
So I'm using the word researchcollective, I'm using an
approach called criticalparticipatory action research.

(15:22):
So what I'm trying to do withinthis approach is kind of
flatten the hierarchy a bitbetween researcher and topic and
people, and by using acollective rather than advisor
group, I'm trying very much tonot just be advised by them but
to actually do what is suggested.
You know, it's perhaps a moredirect um use of advice and

(15:44):
there's nine people, nine in theresearch collective, some I've
had one to one meetings with,because not everyone can make a
meeting.
I think the biggest meetingwe've had is six, six or seven
at one time and it's beenimmensely valuable to me that
really fits in with a lot of thework I do in terms of
co-production.

Florence (16:02):
That idea that from the get-go, you're working
alongside people with nohierarchy that's the other thing
that, when I looked at what youwere doing, made me think this
is really good stuff, becausethis is from the get-go.
You've got the people, theright people, with you to really
understand the questions.

(16:22):
I'm interested in what you justsaid about avoiding
interactions with healthprofessionals in general, or not
seeking medical advice.
And now you've said that to me.
I can see that's obvious.
But I'm thinking oh, I hadn'treally thought about that.

(16:43):
So consciously consciously,even before you've got pregnant,
you're thinking oh crikey, I'mgonna have to go and deal with
health professionals.
Glug, is that kind of whatyou're saying yeah, absolutely
so.

Catriona Forbes (16:58):
One of the things and it was something that
came up in one of thecollective meetings as we were
talking about how a few of usknew that if you're a higher
weight in early pregnancy,you'll be prescribed a higher
level of folic acid, but it isavailable as prescription only
and before getting pregnant.

(17:19):
If you're attempting to getpregnant, you are advised to be
taking folic acid to prepare forpregnancy, but I personally
certainly did not have anyconversation with my general
practitioner about whether I wasattempting to get pregnant to
then ask if I could thereforehave the prescription for the
higher level folic acid thatwould be recommended, even
though I knew that that's athing, and so I did not seek out

(17:43):
that prescription in advance oftrying to get pregnant, because
I wasn't interested in theconversation about whether
getting pregnant at my size wassomething that they perhaps
should be doing or isrecommended, because we don't

(18:07):
want to have that conversationabout decisions that we're
taking about starting a familyor expanding our family for
those that already had children,and so, yeah, it's a key
example of the way that webefore pregnancy, even if you
are aware of that beingsomething, and the best
recommendation would be thatperhaps we should go and get

(18:27):
that prescription as part of thepreparing for pregnancy journey
, and we don't um, or you knowthose of us who are discussing
it, haven't?

Florence (18:34):
perhaps some do so we've got two kind of barriers
there, I'm thinking, becauseyou've got the barrier of it's
prescription only, whereasanyone else can go and buy what
they need over the counter, yeah, and then the barrier of you
don't actually want to go andtalk to the person that's able

(18:55):
to do the prescription.
Yeah, it's like a bit of adouble whammy.

Catriona Forbes (18:58):
Well, I certainly purchased what you can
purchase over the counter anduse that, but I was aware that
it may not really be what Ineeded.

Jenny Cunningham (19:08):
you know, at my at my weight that was an
eye-opener for me in thatmeeting because I had read
research around people notwanting to go to their doctor,
their family doctor, because, asKatrin has described really
well, you know you go in withwhatever pain or problem and
weight can be the kind of thefirst conversation or maybe all

(19:29):
that appointments around weightor losing weight.
I should say that's what it'sabout, isn't it?
So it's kind of known thatpeople of a higher weight will
often not go to appointmentswith delay, so diagnosis gets
delayed, they may get illerbecause of this, etc.
Etc.
So there's a really pooroutcome, potentially poor
outcome.
But and I was wondering whetherit was different in maternity

(19:52):
and then the the research I'dread up until you know, hearing
that conversation was aroundpeople may again anticipate
stigma, but they will turn upbecause they're pregnant and
this is what katherine saidearlier.
You turn up, you go down thepathway because you're pregnant
and you're not there just foryourself, you're there for your
baby.
So weight stigma plays adifferent role but of course,

(20:12):
preconceptually it really playsinto that kind of people not
wanting to see a healthcareprofessional, and that's really
important information to know.

Florence (20:24):
So, talking about weight, stigma and shame, you
have given some good examples inthe work you've done about
various moments in that pathwaythat you might encounter that

(20:46):
sort of stigmatizing moment orshame.
So you mentioned actually beingweighed, but also things about
ultrasound scan and stuff likethat.
So I don't know if you want totalk a bit about that, of course
, thank you, yeah so I havecompleted a type of systematic

(21:08):
review.

Jenny Cunningham (21:09):
It's called a meta-ethnography it's enough to
put anyone off reading aboutresearch these terms.
But basically I'vesystematically reviewed the
evidence and all the studieswhich included a finding of
weight stigma or with a weightstigma focus around maternity
kind of pregnant women, people.
So I was looking at studieswhere people were interviewed or

(21:30):
part of focus groups, so it waskind of the written word.
In the end I found 38 studiesand one of the key findings of
these 38 studies from around theworld was shame.
So I conceptualised thefindings into the first person
so I experienced shame duringmaternity care was across all

(21:51):
but I think one of the studies.
So shame is a factor.
During the ultrasound scan itcan be realized as like mother
blaming, mother blame where, uh,in this case it's the woman's
size.
Maybe the sonographer says Ican't see your baby very well,
or maybe maybe all themeasurements are taken
satisfactorily as far as thewoman knows.
But when she gets her notesback, there's a little comment

(22:13):
in the notes saying visibilityrestricted due to maternal
habitats.
I think it's a common one andit appears that even when the
sonographer at the time has saidyes, everything's fine and
appears to be ticking everythingoff.
Even in those situations canthis little sentence be written
in the notes?
And of course the woman mightnot see it till she's home, and

(22:36):
then that's a really can bepotentially quite humiliating
thing to read, because thatwasn't addressed in person at
the time.
So that was found in quite afew studies and that's also
popped up in my own study too,when this scan seems particular
area, particular time, and Idon't know why because I haven't

(22:57):
talked to sonographers aboutthis.
But I will do.

Florence (22:59):
But it is a real issue and it's obviously partly to
the technology maybe not beinggood enough or may not be the
right type of technology you'recorrect, it is partly related to
the technology and its abilityto go through different layers
and different depth of layers,because it's ultrasound that is

(23:21):
bouncing back and forth betweenthe probe and the baby.
I feel that maternal bodyhabitus thing is a little bit
like when you buy something andit's like a little guarantee
don't sue us if we've done itwrong.
So when they go, all this andthe other can't be excluded

(23:42):
because of you were noddingalong there.
Cat Catriona, would you like toshare anything about your
experience of scanning or whatwas making you nod?

Catriona Forbes (23:54):
Well, I had a fairly straightforward
experience of scanning.
I was quite open in going intothe appointment and asking if it
would help if I held my tummyin a particular way.
That would allow them toobviously get to wherever they
need to be.
That would allow them toobviously get to wherever they
need to be.
So I was just fairly open aboutthe fact that, you know, I may
in fact have body fat that getsin the way and you know it's

(24:15):
perhaps helpful to just move itback or whatever that might be
to hold it in place.
So I was quite open about thatin the scans.
But I definitely had theexperience that Jenny describes,
where a scan took place, allthe measurements were taking
place.
There was, you know, adiscussion about whether all the
measurements, whether theycaptured everything they needed
In one scan my 20, my firstattempt at a 20 week scan.

(24:38):
We couldn't, but it was entirelyabout the baby's position and
that's what they'd said and I'dhad to do.
You know I'd done everything.
I'd had to go for a walk, I'dhad to try drinking very cold
water to shock the baby intomoving, bit and go and empty my
bladder, wait a while again andsee.
So I'd done various things inthis appointment to attempt to
move baby and then baby was notup for moving.

(24:59):
I don't think I've ever donesuch bizarre movements on a kind
of hospital table thing to tryand get a baby to move.
It didn't work so I had to goback for a repeat scan.
Then we went up for a repeatscan, baby was in the right
place and they got all themeasurements, but then, yeah, I
went home and that note wasadded.
So then I think the experienceis you then question well, hold

(25:19):
on, did you get all themeasurements you need?
Like I thought we did geteverything we needed, but now
this note's there.
So did you get everything youneeded?
And then, obviously it's, itturns out on all the notes.
So then you kind of have thequestion of wait, have we ever
had the measurements we need?
And so it just kind of puts thatuncertainty in place of
particularly, I think, becausescans started to become part of

(25:41):
the discussion about, obviouslythe size of my baby and then
what that might mean fordelivery of my baby and it, I
think, because there's that noteand then there's not really
been a conversation about whatthat actually means.
You then start to question well, how can you be basing so much
on something that you've added anote that may be inaccurate

(26:02):
yourself?
How am I supposed to take thisas an accurate assessment for
something else, when youyourself have said it's possibly
not an accurate assessment?
So there's this kind of weirdconflict of what advice am I
supposed to take here?
Because, on the one hand, thisis the most accurate evidence
that you have to make clinicaldecisions, but on the other hand

(26:24):
, you've acknowledged that itmay, in fact, not at all be
accurate because of my body.
So it does kind of presentsquite a juxtaposition of how to
even like participate in theconversations about plans going
ahead based on scans.

Florence (26:41):
That's a really good point, because I'm assuming
you're then thinking about atthe end of pregnancy, if someone
tells you your baby's big andis starting to talk about
decisions to do with that,because higher weight women
there seems to be a correlationwith a higher weight baby,

(27:02):
although I don't know if that'sactually true, but that's
certainly what we've written inour guidance, that we should be
doing a 36-week scan to decide.
But then you're right, howaccurate are those measurements
and then influencing all sortsof choices rippling out from
there.
Just I wanted to pick up onwhat you said about being very

(27:27):
open in appointments and thatyour body fat.
You might need to hold it outthe way.
I always find it reallydifficult to know the right way
to approach a conversation,particularly if a woman has
perhaps been, like you said, puton the pathway to see me

(27:50):
because she's ticked a certainbox.
Then to say, well, you're herebecause you're a heavier weight,
and yet that just seems veryrude.
But then you can't not mentionit because that's why the

(28:10):
woman's potentially been askedto come to the clinic.
So do you have some?
And I guess I usually open upthe conversation by asking the
woman why are you here?
What can I do for you today andthat sort of open question.
But do you think there's a goodway to approach that?

Catriona Forbes (28:34):
it's a good question.
What is the good way toapproach that?
I mean, I guess the challengeis there is no one good way to
approach it.
Everybody is their own.
You know, I, I guess,approached it the way I did in
scans because I guess I was abit more matter of fact.
I, you know, there was thatmention at the start where I'm
already pregnant.

(28:55):
How helpful is it to be talkingabout my body size at this
point?
You know, this is the body thatis going to be, you know, if
all goes well, birthing a childlater.
So we might as well all justwrap our heads around that now
this is the body that will bedoing that.
So you know I guess that waskind of a part of my mindset was

(29:15):
well, this is the body I have,so this is the body we're
working with.
There's nothing really todiscuss or expand on there um, I
don't really remember how myfirst discussion went with my
consultant because it was overthe telephone and I really don't
remember what the opener of itwas, but I do remember I do

(29:37):
hypermobile EDS and so I didhave questions relating to that
Because that for me was actuallylike a large concern for me.
I remember trying to askquestions about it and it was
just dismissed as kind of thatwas not something that was of
any concern to my consultant andin a way, initially that seemed

(29:58):
like a positive thing.
It's like, oh, it's not a worryfor them, they're actually fine
with this.
And I think as things went onand because I started to have
more questions about that, Iactually started to feel really
frustrated that that wasn't aconcern actually because we were
talking about things.
That obviously was the concern.
That had been the reason that Iwas flagged to the pathway, but

(30:20):
then there wasn't room for meto talk about the concerns I had
, it felt like.
So I don't remember my openerconversation, but I also feel
like there's just somethingpowerful in someone saying the
reason that you've been referredto this is because of these
risk markers that have beenchecked off.
I do have a tale of a reallypositive experience, which is
one of my best friends who alsoended up on a consultant-led

(30:44):
pathway of BMI kind of being thedriving factor who in the first
appointment with her consultantbasically the consultant had
obviously looked at records andthen looked up and was kind of
like, okay, and I think he hadactually said, well, you know,
your referral is based on yourBMI because you've ticked this
thing, but having looked throughyour records, um, this is going

(31:08):
to be an incredibly boringpregnancy for me.
And you know it was very muchlike unless something actually
happened, you know, unless herBMI suddenly shot up or unless
you, you know, developedgestational diabetes or unless
she any other number ofconditions that can occur in
pregnancy happened.
It was otherwise just going tobe a meeting someone with a

(31:31):
perfectly normal pregnancy thatjust happened to be on his book
because her BMI was too high,and so I think that kind of
brought like just, you know, itwas an opener.
This is why you're coming to me.
There's really nothinginteresting for me to talk about
yet.
Hopefully that will remain andthat was just kind of a nice way

(31:52):
to open it with, like you'rehere because of this, but
looking at these papers, you'requite boring at this point, um,
and hopefully you'll stay thatway, um.
So you know, I think there'ssomething powerful in just
acknowledging, you know, it'sactually quite boring, I would
imagine, to just have to.
You know, even for medicalpractitioners, you just like,
this is just a process we'realso going through, that there's

(32:13):
certain thresholds that are metand that need to be ticked, and
that we have to follow theprotocol.
But fundamentally, x number ofpeople will never even become
interesting in this kind ofmedical context.
So you know, she had a reallypositive experience in that
respect because and she didremain boring, uh, right through
to the end- I like that story.

Florence (32:33):
That's really great.
Can I just come in here?

Jenny Cunningham (32:37):
yes, do me again going back to my kind of
not my, but this this themearound shame and how people are
shamed, um, with higher weightand pregnancy.
It's those assumptions and thekind of preconceptions people
have.
You know, midwives and doctors,when that woman walks in the
door who all we see is someoneof a higher weight.
And inevitably obviously I'mparaphrasing what people might

(33:00):
think but inevitably this personis going to end up with X and Y
.
But the example Catriona justgave of her friend was there was
none of that kind ofpreconception of those judgments
given to that woman, which iskind of what you want.
So it is completely reducing,minimizing any kind of feelings
she may have about her size,because this doctor is just

(33:21):
saying well, it might not be theright system, but you're here.
But you know I'm notanticipating anything bad's
going to happen and I thinkpeople in the review I did women
are tend to be being told thatyou're going to have a cesarean
section, you're going to beinduced, you know you can't go
to the midwife led unit.
So right at the beginning,throughout, they're being

(33:41):
restricted, they're being toldbad things will probably happen.
But of course we don't knowthey're going to happen, do we,
and maybe by saying this bad,you know these kind of giving
those expectations, maybe we ashealthcare professionals is what
these things are more likely tohappen and I haven't done the
research to say that but who'sto say that isn't the case as
well?

Florence (34:01):
yeah, I worry about that.
I was thinking about whatCatriona said about actually I
was interested in myhypermobility and you know
Stannis syndrome and theconsultant wasn't at all
interested in that.
They were focused on the weightand that's a kind of classic
really not listening to andthinking about what matters to

(34:23):
the person in front of you.
I agree, I worry.
One of the things I see quite alot is the idea of oh, it might
be difficult to put in anepidural, so we're going to make
you be on the obstetric unitbecause you're in inverted

(34:45):
commas, high risk, and you can'tgo to the birth centre and you
can't use the birthing pool, allsorts of restrictions we're
going to place on you.
And then we're going to tell youyou ought to have an epidural
because it might be difficult toput it in and therefore we
should put one in just in case,and then we can even.

(35:06):
I've even had people be toldwell, I know you don't want an
epidural, but we'll put one inin case, but we don't
necessarily need to put anymedication down it, but it's
just there when and if we needit or you need an induction.
But that increases your chanceof emergency cesarean and a

(35:28):
planned cesarean would be saferthan an emergency cesarean.
So maybe we should just do aplanned cesarean rather than
having an induction.
We start to kind of perpetuatemore complications, more
interventions, because we're soworried about the possibility
they might happen, we actuallymake them happen.
So worried about thepossibility they might happen,

(35:50):
we actually make them happen.
Catriona, I'm interested inwhat conversations you may have
had or choices you felt you didor didn't have when you were
thinking about giving birth well, yeah, so at 35 weeks I
developed a hypertension.

Catriona Forbes (36:10):
So pregnancy induced hypertension kicked in
at 35 weeks for me and that wasexactly the point.
I was about to be having birthconversations and then a lot of
things went out of the window.
Anyway, I never had anyintention of having a home birth
.
That was never a discussion.
I was actually very comfortablewith the idea of hospital birth
.
Anyway, I was intending orplanning to have hospital birth,

(36:33):
ideally a water birth, but thatwould unlikely have been
granted, even if not for thehypertension, because of
policies around water births andweight.
But I did have a birthpreferences conversation I had.
I was in and out of hospitalstays to try and get the
medication at the right level tomanage it.

(36:53):
My midwife still had a birthpreferences conversation with me
.
So I checked out of hospitalone day and came home and think
I had the conversation laterthat day with my midwife, came
to my house but we could talkthrough what the options were at
that point.
Obviously, induction had beenspoken about, uh, quite
extensively on when I was on thehospital ward and I was very

(37:17):
against induction.
So I was very much of themindset that if my baby wasn't
choosing to come out and therewas a medical reason why my baby
needed to be delivered with anysense of immediacy, then that
would be the cesarean, becauseto my mind I don't see how an
induction really is aboutdealing with an emergency
delivery situation, given thatthey can take so long.

(37:40):
So for me those were kind of mythresholds was that unless I
went into labour naturally andmy baby was obviously ready to
come, then cesarean was the onlyroute that I was willing to
discuss as the alternativedelivery, I guess.
So I did have hard lines aroundwhat I did and didn't want, and
when I had the same discussion,I guess, with my midwife, we

(38:03):
obviously spoke about the painoptions and what I might or
might not want to consider, andI'd done an NCT class, albeit
entirely online also, withanother group of expectant
parents, so kind of.
I had enough knowledge aboutall of those processes and the
kind of delivery things anywayand all the different pain
medications and the differentphases of labor and things like

(38:26):
that.
But yeah, I guess I had quite ahard line on it's a, it's a
natural kind of own accord or ifit's that emergency, then a
cesarean is the way we'll needto go.

Florence (38:36):
Then I guess, and it we did end up with a cesarean,
the timing of which, yeah, forthe days leading up to my
cesarean they'd everything hadremained pretty stable, but
there was a fear about allowingme to go over the weekend, and
then they're not being moresenior staff, so friday delivery
it was by cesarean yeah, I'minterested in that and whether

(39:02):
you felt that choice wasrespected, because we can often
think about restrictions interms of being allowed in
inverted commas to use birthcentre or have midwifery led
birth or home birth, but in thekind of modern era where we

(39:24):
accept maternal request ormaternal wishes as being a valid
reason for a cesarean birth.
I do remember the first time ahigher weight woman came and
asked me for a cesarean becausethat's what she wanted.

(39:45):
And I mean, just to be clear,she she had the cesarean she
wanted.
Yes, it did give me pause for amoment, suddenly thinking well,
some of the complications arepotentially higher for this
woman.
Yeah, such as wound infection,maybe, or deep vein thrombosis.

(40:08):
Yeah, such as wound infection,maybe, or deep vein thrombosis.
And I did have to kind of sense, check in my head that this was
still a valid choice for her,just otherwise I would be
discriminating against her onaccount of her being higher
weight.
Yeah, you know, and I thinkthat's something I had to
consciously wrap my head around.

(40:29):
I mean, it's quite a few yearsago now, I'm pleased to tell you
, but I can't imagine that I'mthe only obstetrician that has
perhaps suddenly thought oh,actually, that needs to be a
valid choice, just in the sameway as if a woman of higher
weight asks me for a home birth.
That has to be a valid choice.
Just in the same way as if awoman of higher weight asked me
for a home birth.

(40:50):
That has to be a valid choice.

Catriona Forbes (40:52):
Yeah yeah, I mean, you know, I guess it is an
interesting conundrum.
I guess for me my choice wasn'tcesarean, my choice was that I
wanted a natural birth.
My choice would have been awater birth.
But that choice probably wouldnot have been available to me
even if I had gone down theperfectly straightforward,

(41:13):
boring pregnancy route.
So I think that the challengersticking point came, that I was
comfortable, I guess, incontinuing with pregnancy as it
was, but my medical team weren'tcomfortable, and so this
sticking point then came aroundinduction versus cesarean.

(41:36):
And I know that there's ahigher incidence of cesarean
from induction.
I just turned 37 weeks pregnantat the point at which I had my
cesarean.
I was very clear about it, butI would say that a number of
different staff did keep seem totaking it in turns to just
double check about my responseto the induction question.

(42:01):
So I did face a number ofdifferent people coming in to
have the discussion around.
We need to talk about inductionyeah my response being well, we
don't, because I'm not going tohave one yeah and and that kind
of being a bit of a hard line,uh sticking point of I'm happy

(42:21):
for my baby to stay where it is.
So if you're not happy for mybaby to stay where it is, then
it seems like we're gonna haveto talk about a cesarean yeah
and so that was kind of thesticking point I guess for me,
like I'm happy my baby is whereit is.
I'd I've been having the extradoppler scans and blood flow was
fine.
You know, as I say, my um bloodpressure in the days the I

(42:41):
guess four or five days, whichhad been the longest period it
had stabilized.
In the two-week period thatthis had kicked off, um had in
effect stabilized, but there wasjust that fear of if it became
unstable, I guess.
So for me I was like I'm happyfor my baby to stay where my
baby is and they weren't.
So that was kind of the butyeah, I definitely had numerous

(43:04):
conversations about induction,but that was very much my red
line of no, we don't need totalk about that, I won't be
having one.

Florence (43:13):
Yeah, I definitely recognize that.
Just checking, repeatedly, justchecking thing, yeah, I'm sorry
to say that that does thatabsolutely is something that I
think we do.
Yeah, it's.
It's difficult, isn't it, toget the right balance between
making sure it's a really wellinformed decision and then

(43:36):
constantly challenging someone'sdecision.

Catriona Forbes (43:38):
Yeah, so for me I had raised concerns around,
you know, for induction I hadconcerns about epidural and the
positions that my legs may haveto be held in and what that
could mean, because I wouldn'tbe able to feel pain or if my
joints were being pushed too faror if I was in a position for
an extended period that Icouldn't recognize that my body

(44:00):
was actually in pain because ofmy hypermobility as well.
I guess I'm more aware of thatand so those things were my
concerns and I did raise thoseas the concerns of these are the
reasons why I have theseconcerns.
It's interesting because I'dhad the birth preferences
conversation with my midwife andshe was really supportive of,

(44:21):
like, the reasonings that I wasgiving and that I had reasons.
And you know I'd thought aboutwhy I had these concern.
You know, I guess it wasdifficult because there'd been
points where I had raisedquestions or concerns around,
you know, being hypermobile upuntil that point anyway and
they'd always been dismissed andeven in trying to have the

(44:41):
discussion at that point therewasn't much in the way of
attempting to providereassurance around that specific
concern or issue.
But I definitely had theconversation as well where I was
made aware of the higher riskof infection with my wound and
you know anesthesiologistsdiscussions as well about the
ease of that and things as well,and so all of the risks

(45:04):
associated with cesarean werealso obviously raised and
discussed as well.
But on balance I had kind ofother concerns around induction
and also just wasn't convincedthat they don't end up in
cesarean anyway.
So all of the things to attemptto put me off a cesarean that
would ultimately be forgottenabout if a cesarean was
determined and needed we're justa bit like.

(45:26):
Well, there's scenarios in whichyou'll completely ignore all of
these concerns too, so I don'tknow why I'm going to put them
at the forefront of my mindexcellent.

Florence (45:37):
Yeah, I would like to know a bit.
So, jenny, in terms of you,you've kind of talked about some
protective things, some things,that good things that we could
do as as health professionals.
Um, so we've talked about quitea lot of negative things.
Now, what are some good thingsthat people could think about or

(46:00):
that you've discovered?

Jenny Cunningham (46:03):
yeah.
So I don't think you'll besurprised to hear.
But what people really valueare individualised care.
There's this expression I reada couple of times women feeling
invisible behind the veryvisibility of their bodies.
So we just see this kind ofperson who's a higher weight,
not actually their aspirationsand who they are, so being seen

(46:25):
as a person, a human being,connecting with them,
individualizing their care.
Um, the evidence also showed afew women spoke about kind of
didn't necessarily call itcontinuity, but seeing the same
midwife or even the same doctor,it was more commonly the
midwife they found reallyhelpful because they didn't have
to start that conversation, aswith any issue or whatever you

(46:46):
know it was, it was there, itwas understood and it would have
been spoken about and a kind ofprotective factor that a couple
of the studies talked about.
About midwives, this is morearound the birth, but they're
kind of like a birthing bubble,kind of supporting them.
For these examples they were,um vaginal births they weren't
well, I think they're in amidwife led unit, but being

(47:07):
really supportive and kind ofsupporting what their bodies
could naturally do in thosesituations to birth their baby.
And the women themselves feltreally empowered at the end of
that and really kind of proud ofthemselves but also really
recognized that support thosehealth care professionals had
given.
So I think, yeah,individualized care, not having
we talked before about thosekind of preconceptions and

(47:29):
judgments people might bringabout what we might expect
someone of a high weight to havein terms of their pregnancy or
their birth, but kind of leavingthat to one side, I suppose,
addressing your implicit beliefs, which we all hold, don't we?
And leave them at the door, soto speak, and kind of talk to
the person one to one and beingopen to as Catrina's friends
heard, and they're open to itbeing really boring.

(47:51):
And as a midwife I used to likesaying this is gonna be,
hopefully again, really boring,really mundane, not mundane, but
you know nothing's going tohappen because it's all just
going to kind of go alongsmoothly, as we hope, and not
kind of, yeah, not sowing seedsof doubt.
But of course you know we haveto talk about certain aspects of
what pregnancy might bring.

(48:12):
You know what someone mightbring to their pregnancy.
So it's not, it's not to shyaway from conversations.
Again being direct and honestand open and, florence, when you
were asking earlier to catchher, and what should you say?
Or what should one say to awoman who comes to a clinic
because she is a higher weight?
And I think being really honestabout you know you being really

(48:33):
honest and transparent with thatindividual, that woman, you
know you've come here becausebecause the evidence I've read
women don't always know why theyappear at consultants rooms or
even there's studies aroundweight management services
another expression I don't likebut I don't even know why
they've they've attended thisclinic because it's all been
hidden, because everyone's a bitembarrassed about it.

(48:54):
So it's being open and honestand being more nuanced around
the around the evidence.
I think if we just say yourrisk is higher or you know your
risk is double, that saysnothing.
So I think definitely beinghonest about we don't actually
know this.
There is some evidence thatsays it goes from a 0.5% risk to
a 1% risk, but that's still youknow it's not scaring people

(49:18):
with statistics and beinginformed as a professional
yourself, so you're not justrepeating not very well
explained risks which I thinkwe're all guilty of at times.
You know becoming the expert soyou can give good guidance and
good advice.

Florence (49:37):
That makes sense.
Catriona, you were nodding awaythere.
Do you want to add to that?

Catriona Forbes (49:42):
Yeah, there is something interesting, I think,
in what Jenny said about beinginvisible whilst also being so
visible based on your size, yeah, is that it's not a secret to a
higher weight person that theyare a higher weight.
They know they have mirrors intheir home, they buy the clothes

(50:02):
that they wear, so they knowtheir size.
So it is a challenging thing, Ithink, to you know, I don't
think there is that sense oflet's just pretend that's not a
thing.
But I think being open aboutthe reason that you're here,
there's probably more than onetick that went into the boxes to
justify it and to then justcreate space to say these are

(50:24):
the things and these are whyyou're here.
Everything else if that forthat person, everything else is
falls entirely within the normalspectrum, it's very much a so,
unless anything special happens,we'll just have a nice chat
every time you come in.
So I think just that opennessof why someone is there, I don't
think anyone should shy awayfrom it in the sense of these

(50:48):
are the reasons and you know,yes, there may be some people
that will get really combative.
You know who've done theirresearch and might know that
it's like well, what are thesebased on and what studies are
these?
You know who've done theirresearch and might know that
it's like, well, what are thesebased on and what studies are
these about?
You know, I'm sure there arepatients that might try that
Maybe I read some stuff.
But you know, there's just thatsense of you know some people
will want to rail against thepathway or the reason that

(51:11):
they've been referred as well.
So I think if that's kind ofthe opener as well, you'll be
able to kind of have thatdiscussion up front too, because
the person who is sceptical ofit all can then share their
scepticism, and you as aprofessional may also have some
scepticism of your own.
You don't necessarily just say,oh yeah, I know these are just

(51:32):
guidelines and we're just havingto follow them.
We're all in the process.
You know, it's not that there'san expectation of that.
It's just that sense of saying,yeah, I can understand that
these are based on studies andparticularly in your first
pregnancy, you definitelycouldn't have been part of them.
So it's not about you, it'sactually just about numbers.
But you're a person and, okay,let's work with you through your

(51:55):
pregnancy.
Um, so yeah, I think thatopenness, probably at the
beginning, would be a more, amore positive opener in my, in
my opinion, but I don't know,maybe there would still be
people that found it incrediblyconfronting to be told that
that's the reason that they'vegot this referral.

Jenny Cunningham (52:10):
But I suppose that's something that can then
at least be gauged or understoodfrom that starting point, if
that's how it opens and I think,also remembering people can
decline, decline appointments,decline to be weighed, decline a
glucose tolerance test, and notagain, not shame them into
making an informed choice aboutwhat they want to do their
pregnancy.
When you work for you know thenhs you're so kind of used to

(52:34):
these conversations, aren't you?
And what?
We know what the expectation is.
Sometimes we're a bit flawed ifsomeone says no.
And again, you know, catriona's,the kind of point you're making
really nicely about how youkept having healthcare.
You know doctors or midwives,whoever it was, coming through
your door saying are you sure?
Are you sure?
And it's kind of you shouldn'thave had that.
I don't think they could havebeen documented in your notes.

(52:56):
Catriona is sure?
Or maybe whoever spoke to youfirst would say someone will ask
you one more time and you canhave that discussion.
But we should allow people todecide and not infantilise them
by thinking we know best.
So allow people not to beweighed, not to have a test,
that's fine, as long as theyunderstand asja only said the

(53:17):
the rationale behind it.
As much as we know, from asmuch evidence as we know, we
people can make their ownchoices and sometimes we forget
that.

Florence (53:25):
I think yes, I agree with you.
I think sometimes we tiptoearound a bit and I find it a big
relief when a woman will say tome well, I'm here, you know,
because of this, or I know mybody's this, that and the other,
or I know I might look likethis, but actually I run, or you

(53:48):
know, whatever they challengemy assumptions, and it makes it
much easier to have aconversation than if we're all
kind of ignoring or tiptoeingaround it.
So I think the advice you'vegiven there, catriona is, is
really helpful, even though itsounds so basic.
We need it, I think.

(54:08):
Jenny, in terms of research,are you still looking for people
to contribute and, if so, howdo they do that or how do they
get in touch?

Jenny Cunningham (54:21):
Yeah, I'd love to kind of speak to a couple
more women.
I particularly would beinterested to speak to someone
of South Asian heritage, becauseI've not spoken to anyone from
that background.
So that would be great ifanyone could get in touch.
The university email addressI'm also on twitter called x,
and instagram as jenny midwifeor phd jenny midwife, so you can

(54:44):
find me there.
I've, having done this kind ofreview as I spoke about before,
I'm now interviewing peoplehopefully three times twice in
pregnancy and once physically tofind out about their
experiences.
And I've interviewed 10 peopleso far, which is great.
Someone more than once andeveryone has a very different
experience, as you can imagine.
But I think common throughoutis it's anticipated fear is

(55:10):
perhaps too strong word, butthat expectation they're going
to be kind of told off or haveweight discussed or be
embarrassed, so that's that'scommon throughout.
All that kind of told off orhave weight discussed or be
embarrassed, so that's that'scommon throughout.
All that kind of planning thenext appointment or planning the
first appointment comes up alot.
The scan I've already mentionedthat.
That comes up quite a bit.
Checklists of risks that seemsto be quite a common theme too.

(55:31):
So maybe not a great discussionbut kind of ticking off a list
of things we.
The risk we've talked about andactually interesting, certainly
haven't but we've touched on isa lack of discussion about where
to have the baby.
It seems to me and I don't knowif this just generally happens,
you know, because time's sotight at the moment in the NHS

(55:52):
with appointment times but I'mbeing told that women have
themselves have to initiatewhere I might have my baby.
Again, whether it's to do withsomeone's high weight and the
midwife isn't sure, the doctorisn't sure, and I spoke to
someone the other day.
She was actually in activelabour before she was told
definitely she could birth inthe midwife led unit.

(56:13):
She kind of asked and asked andso she actually was in hospital
in active labor and then gotthere.
So there's something aboutputting off those discussions
which kind of interests me.
So we'll see if that continues.

Florence (56:25):
So yeah, I'd love to talk to two or three more people
if they're interested that'sfine, and I can put all those
links and things in the in theshow notes.
So I think I've probably takenup enough of your time.
So we're kind of coming to theend and I normally end with a
zesty bit, a bit the kind ofreal essence key bit that we

(56:48):
want people to remember from ourconversation.
And my audience is mixed, so wehave midwives, student midwives
, obstetricians listening, butalso women and birthing people
themselves.
So it may be the same for bothof them or it may be that
there's a different one for eachgroup.

(57:08):
I think what I'm going to takeaway is higher weight as a
phrase.
That's really very simple, butsomething that immediately I
think I can use in opening upthe conversation in my clinic by
saying one of the reasonsyou've been sent to see me is
because you're of higher weight.

(57:28):
Let's talk about that.
What do you know about that?
You know, but also, what do youwant to talk to me about today?
You know that's one of thethings I need to talk to you
about.
But what do you want to talk tome about?
Because I'm really taking onboard what Catriona has said
about.
Actually that wasn't what shewanted to talk about.
So so have either of you got,or you can have your own zesty

(57:54):
bit or a joint zesty bit,depends what.
What do you think you reallywant people to remember?
Perhaps if we start withkatriana?

Catriona Forbes (58:02):
I guess the takeaway or the wraparound for
everything is that maybe let'snot approach everything as if
there's a problem before there'sa problem.
That's nice so yeah, let's gointo things.
Until there's a problem, thereis no problem and, and maybe
that's the the easiest approachto take things with and to to be

(58:26):
able to have those safe andneutral discussions that allow
people to listen and also to beheard, I guess.

Florence (58:35):
I think that's a really good point.
Taking out of it being higherweight in itself is not a
problem.

Catriona Forbes (58:45):
Yeah, until a problem happens, yeah, which may
or may not be related, might besomething completely different
exactly, and I think it's thatthat point as well, about let's
not treat something as a problemuntil it's actually a problem
is also um, I guess that's alsothe advice I should have given
to myself in going into thoseappointments, as well as these

(59:06):
kind of anticipations andassumptions of how it was going
to be.
I was having that before it hadhappened.
So it's it's not just aboutpractitioners approaching it as
a until there's a problem, let'snot think there's a problem.

Jenny Cunningham (59:21):
I think that's how most women learned.
You know, when they first hadtheir midwife, they'd have had
appointments, negativeappointments, probably
throughout their lives yeah, Ithink it's just that challenge.

Catriona Forbes (59:32):
Isn't it to yourself that it's like?
If you expect a healthcareprofessional to treat you as an
individual, perhaps we also needto treat them as individuals
and not assume that they'recoming in with the same baggage
and opinions and load as anotherhealth practitioner has brought
into the room when you've seenthem, so it's.
I know that obviously there's asystem that everyone exists

(59:55):
within, but right now I'mspeaking to an obstetrician and
a midwife that both don'tnecessarily subscribe to that
system.
So you know, it's also a lessonto think about from a user's
perspective.
If I want to be treated as anindividual, maybe I'll just
approach appointments as I don'tknow this person.
I've not met this person yet.
I don't know what their opinionor approach with me is.

(01:00:17):
So until there's a problem,there is no problem.

Florence (01:00:21):
I like that.

Jenny Cunningham (01:00:22):
I like that too.

Florence (01:00:23):
Thank you that, I'll write that do you want to add
anything to that, jenny, or isthat the last word, do you think
?

Jenny Cunningham (01:00:33):
I mean I was, I would have said in a different
way, but I liked Catriona's wayfar better.
It's, yeah, seeing the personbe, you know, human to human
connection, seeing the personfor who they are and their hopes
, and don't prejudge.
Catriona says it much betterthan I do.
She always does excellent.

Florence (01:00:54):
Well, thank you both very, very much.
I think that's been a reallyinteresting conversation which
will hopefully give people lotsto think about and hopefully
have some better conversationsand more holistic conversations
with less assumptions.

Catriona Forbes (01:01:13):
So thank you both very, very much thank you,
it's been really great to talkto you.

Florence (01:01:20):
I very much hope you found this episode of the OBS
pod interesting.
If you have, it'd be fantasticif you could subscribe, rate and
review, on whatever platformyou find, your podcasts, as well
as recommending the OBS pod toanyone you think might find it

(01:01:40):
interesting.
There's also tons of episodesto explore in my back catalogue
from clinical topics, my careerand journey as an obstetrician
and life in the NHS moregenerally.
I'd like to assure women I carefor that I take confidentiality
very seriously and take greatcare not to use any patient

(01:02:05):
identifiable information unlessI have expressly asked the
permission of the personinvolved on that rare occasion
when it's been absolutelynecessary.
If you found this episodeinteresting and want to explore
the subject a little more deeply, don't forget to take a look at

(01:02:29):
the programme notes, where I'veattached some links.
If you want to get in touch tosuggest topics for future
episodes, you can find me attheobspod, on twitter and
instagram, and you can email metheobspod at gmailcom.

(01:02:49):
Finally, it's very important tome to keep the ObBS pod free
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So if you've enjoyed myepisodes and, by chance, you do

(01:03:11):
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